Aripiprazole, a Novel Atypical Antipsychotic Drug
Aripiprazole, a Novel Atypical Antipsychotic Drug
Before the 1990s, treatment of psychoses centered on conventional agents whose tolerability was limited by extrapyramidal side effects (EPS). The past decade has seen the emergence of a newer generation of antipsychotic agents, first with clozapine and followed shortly by risperidone, olanzapine, quetiapine, and ziprasidone. These agents have been touted as providing better negative symptom efficacy, less impaired cognition, and lower risk of extrapyramidal syndromes. However, evolving evidence suggests that several drugs in this class may be associated with significant weight gain and lipid abnormalities. Aripiprazole, a new atypical antipsychotic drug, displayed efficacy similar to that of haloperidol and risperidone and superior to that of placebo in numerous clinical trials. Aripiprazole does not cause significant prolactin elevation and is associated with a low rate of clinically significant weight gain compared with other atypical antipsychotics. Patients receiving aripiprazole experienced EPS at a rate similar to that seen with placebo. Aripiprazole provides a new treatment option with limited adverse effects for patients in need of antipsychotic therapy.
Schizophrenia is a disabling and devastating illness characterized by a constellation of psychotic, mood, and cognitive symptoms. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), schizophrenia is defined by these symptoms, which are classified as positive and negative, and by deterioration in interpersonal and occupational relationships, all observed over a period of 6 months or longer.
Patients with schizophrenia often are stigmatized, although the disease is relatively common; an estimated 0.5-1.5% of the United States population is afflicted with schizophrenia. Economically, the treatment of schizophrenia consumes approximately 2.5% of total annual health care expenditures. Hospital readmission is common, and the cause is often ineffectiveness of or noncompliance with pharmacologic treatment. The development of adverse effects often plays a role in patient noncompliance and occurrence of relapse.
Extrapyramidal side effects (EPS), such as akathisia, dystonia, parkinsonism, and tardive dyskinesia, were once thought to be an unavoidable consequence of antipsychotic treatment. Newer atypical antipsychotic agents have emerged in the last decade, such as clozapine, olanzapine, risperidone, quetiapine, and ziprasidone. These agents are clinically effective and carry a much lower risk of EPS than conventional antipsychotic agents. Clinically, the advantages of atypical agents may also include better control of negative symptoms, less dysphoria, less impaired cognition, and lower risk of tardive dyskinesia.
Conversely, weight gain remains a problematic adverse effect of most atypical antipyschotics. Aesthetic effects of weight gain may have a substantial impact on the patient and on compliance. Equally important are metabolic abnormalities such as glucose dysregulation and hypercholesterolemia that may result from weight gain or other pharmacologic actions of antipsychotics. Sedation, orthostatic hypotension, QTc prolongation, and sexual dysfunction are other adverse effects seen in patients receiving treatment with atypical agents.
Factors that require consideration when selecting an antipsychotic drug are cost, availability, feasibility of compliance, dosing schedule, and adverse-effect profile. Aripiprazole, a novel atypical antipsychotic agent, was approved by the Food and Drug Administration (FDA) in November 2002 for treatment of schizophrenia.
Before the 1990s, treatment of psychoses centered on conventional agents whose tolerability was limited by extrapyramidal side effects (EPS). The past decade has seen the emergence of a newer generation of antipsychotic agents, first with clozapine and followed shortly by risperidone, olanzapine, quetiapine, and ziprasidone. These agents have been touted as providing better negative symptom efficacy, less impaired cognition, and lower risk of extrapyramidal syndromes. However, evolving evidence suggests that several drugs in this class may be associated with significant weight gain and lipid abnormalities. Aripiprazole, a new atypical antipsychotic drug, displayed efficacy similar to that of haloperidol and risperidone and superior to that of placebo in numerous clinical trials. Aripiprazole does not cause significant prolactin elevation and is associated with a low rate of clinically significant weight gain compared with other atypical antipsychotics. Patients receiving aripiprazole experienced EPS at a rate similar to that seen with placebo. Aripiprazole provides a new treatment option with limited adverse effects for patients in need of antipsychotic therapy.
Schizophrenia is a disabling and devastating illness characterized by a constellation of psychotic, mood, and cognitive symptoms. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), schizophrenia is defined by these symptoms, which are classified as positive and negative, and by deterioration in interpersonal and occupational relationships, all observed over a period of 6 months or longer.
Patients with schizophrenia often are stigmatized, although the disease is relatively common; an estimated 0.5-1.5% of the United States population is afflicted with schizophrenia. Economically, the treatment of schizophrenia consumes approximately 2.5% of total annual health care expenditures. Hospital readmission is common, and the cause is often ineffectiveness of or noncompliance with pharmacologic treatment. The development of adverse effects often plays a role in patient noncompliance and occurrence of relapse.
Extrapyramidal side effects (EPS), such as akathisia, dystonia, parkinsonism, and tardive dyskinesia, were once thought to be an unavoidable consequence of antipsychotic treatment. Newer atypical antipsychotic agents have emerged in the last decade, such as clozapine, olanzapine, risperidone, quetiapine, and ziprasidone. These agents are clinically effective and carry a much lower risk of EPS than conventional antipsychotic agents. Clinically, the advantages of atypical agents may also include better control of negative symptoms, less dysphoria, less impaired cognition, and lower risk of tardive dyskinesia.
Conversely, weight gain remains a problematic adverse effect of most atypical antipyschotics. Aesthetic effects of weight gain may have a substantial impact on the patient and on compliance. Equally important are metabolic abnormalities such as glucose dysregulation and hypercholesterolemia that may result from weight gain or other pharmacologic actions of antipsychotics. Sedation, orthostatic hypotension, QTc prolongation, and sexual dysfunction are other adverse effects seen in patients receiving treatment with atypical agents.
Factors that require consideration when selecting an antipsychotic drug are cost, availability, feasibility of compliance, dosing schedule, and adverse-effect profile. Aripiprazole, a novel atypical antipsychotic agent, was approved by the Food and Drug Administration (FDA) in November 2002 for treatment of schizophrenia.